Breast augmentation, also called augmentation mammaplasty, is surgery to enhance breast size through the placement of breast implants. Contrary to what we are led to believe by media and some other celebritites who exploit their unnaturally excessive augmentation, most breast augmentation candidates don't desire overly large breasts. Most women seeking breast augmentation simply wish to bring proportion to the female body, to enhance a naturally small breast, or to restore breast volume loss due to pregnancy and/or breastfeeding.

Women who undergo breast augmentation by credentialed, skilled, experienced plastic surgeons report very high satisfaction, not only in appearance, but also in the way their breasts feel. Much of the key to your success in breast augmentation, as with any plastic surgery procedure, is to consult with a qualified, board-certified plastic surgeon. He or she should have experience in breast augmentation and other breast procedures. In addition, the surgeon you choose should listen carefully to your goals for surgery--the physical change you want to achieve and how you expect breast augmention to enhance your quality of life.

Before

After

Breast implants are not considered by the U.S. FDA to be lifetime devices. Realistic expectations for breast augmentation include accepting that during your lifetime your implants may need to be replaced.

How it's done

Breast implant size and shape is determined by a number of factors, namely the amount of increase in breast size you desire and how much breast tissue you naturally have. Also, the size of your frame and elasticity of your tissues may limit the size of implant that can be placed. Breast implants are measured in size by cubic centimeters (ccs) and may contain silicone or may be filled during surgery with saline.  The silicone implants feel more natural, do not ripple as much as saline implants, and they do not deflate.  Most people prefer these implants to saline, but a woman must be at least 22 years old to be able to have them.  And, although they do not deflate, they may rupture.  (It has been proven, however, that they do not cause systemic autoimmune disease). Position may be:

Eyelid surgery can be performed on the upper eyelid, lower eyelid, or both.

Upper eyelids 

Upper eyelid surgery restores a smoother and more alert appearance to the upper eyelid. It requires an incision generally made in or below the natural crease of the upper eyelid, through which:

• Excess skin and tissue is excised (cut out)
• Fat may be removed or redistributed
• The muscles of the eyelid may be repositioned or a portion may be removed

The length and shape of the incisions depend on the degree of excess skin that exists. The incision is closed with removable or absorbable very fine stitches.

Lower eyelids 

For lower eyelids, the puffiness and bagginess of the lower eyelid that creates a tired or sad appearance can be corrected three ways:

• Through an incision hidden inside the lower eyelid (for fat removal)
• Through an external incision just below the lower eyelashes (for skin and/or fat removal)
• Through an incision in the upper eyelid (for horizontal tightening and/or an upward slope)

Fat is removed through an internal or external incision. Only external incisions allow for removal of excess skin. When the lower lid is lax or severely sagging, canthoplasty or canthopexy can be performed. These procedures tighten the lower lid in its horizontal dimension and may upturn the outer corner to varying degrees. The lower lid outer attachments to the bone (tendons) are changed in order to correct the lax eyelid. Canthoplasty repositions and reinforces the lower eyelid by cutting and permanently repositioning the lower eyelid tendons. Canthopexy stabilizes and may upturn the lower eyelid tendons using an internal suture to anchor the tendon to bone. Incisions are closed with fine sutures.  

What to expect 

When performed alone, eyelid surgery may be performed under local anesthesia, often with sedation, or under general anesthesia. Eyelid surgery is an outpatient procedure in most cases, performed in an office-based, ambulatory, or hospital-based surgical facility. 

When your procedure is completed, your eyes will likely be teary, with somewhat blurry vision. Ointment may be applied to your eyes. Your eyes may be very puffy, swollen and begin to bruise. You will be released to the care of a responsible adult family member, friend or caregiver who will need to stay with and assist you for at least the first 24 hours following surgery. Cool compresses will help to alleviate any discomfort as will oral medications. It is imperative that you rest and sleep in an elevated position and that you not bend forward for any reason.

You will not be able to wear contact lenses until your surgeon advises that you may resume doing so. If you wear hard lenses, you may need refitting. To keep your reyes well lubricated, you will be given special drops to use as directed, and you will also be given instructions for cleansing your incisions and ointment to help them heal. 

You may resume light daily activity as soon as you feel ready. You must not do any bending or heavy lifting. You will likely be sensitive to bright light, and your eyes will feel dry for a while. Be sure to use your drops and ointment, as prescribed, to alleviate dry eye condtions. 

Your responsibilities 

Patients will be advised to stop smoking for several weeks before eyelid surgery and until healing is complete. In addition, you will likely be advised to stop taking certain medications and supplements for several days prior to surgery and immediately afterward. The success of your surgery is greatly influenced by wound care taken and the use of prescribed eyedrops and ointment. 

Your goals 

Correction of the upper eyelid and the smoother contour of the lower eyelid will be obscured by swelling and bruising immediately following surgery. These changes should subside greatly within the first week and continue to improve over the next two to four months. Soon after sutures are removed and incisions have healed, you may use makeup to camouflage bruising and scars. The scars from your external incisions will continue to change and fade over the next six months or more. Over time, you may not even notice these scars; they are placed so that they are concealed in the natural crease of the upper eyelid and by the lower lash line. All scars are permanent.

Your view 

To friends and family you will look well-rested and happier. Some may not even relate this to an improvement in the appearance of your eyes. They will often think you have been on a very relaxing vacation, or that the stress and strain of daily life has lessened. 

The eyelid area is one of the first regions of the face to show the signs of aging. The skin of the eyelids is the thinnest and most delicate in the entire body. The eyelid area is one of the most animated parts of the face, with strong muscles creating multiple expressions. It is, therefore, understandable why eyelid surgery is one of the most popular rejuvenative plastic surgery procedures. Inherited features such as shallow bone structure and a down-turn of the outer corner of the eye tend to cause bagging of the lower eyelid at a much earlier age.

The appearance of saggy eyelids at any age can make a well-rested person look tired and a happy person look sad or even angry. Eyelid surgery (called blepharoplasty) improves the appearance of the upper and/or lower eyelids by restoring or creating a smooth upper eyelid contour and correcting excess drooping or puffiness (bags) in the lower eyelid. Eyelid surgery does not change the position or nature of the eyebrows. (The procedure to correct these conditions is a brow lift.) Eyelid surgery does not correct crow's feet, although it may improve them somewhat. Canthopexy and canthoplasty are related procedures that tighten the outer tendons in the lower eyelid to uplift the outer corner and prevent drooping.

Eyelid surgery may be performed by a board-certified plastic surgeon, a board-certified ophthamologist with added surgical training in occuloplastic or ophthalmic plastic surgery, or a facial plastic surgeon (an otolaryngologist with added training in facial plastic surgery).

Before

After

Are you covered?

Eyelid surgery is generally an aesthetic procedure and is not eligible for reimbursement by insurers. Occasionally, when the upper eyelids are so lax that vision is obscured, insurance may cover a portion of the procedure. A thorough eye exam, including visual fields, must be performed by your ophthalmologist, and precertification must be obtained.

Good candidates

Good candidates for eyelid surgery include healthy adult men and women with puffy or sagging eyelids. There are certain conditions that require special considerations before eyelid surgery. If you have eye diseases such as glaucoma, detached retina, Grave's disease or other diseases that affect your vision, you should have the approval of your ophthamologist prior to surgery. You should also have approval by your primary care physician if you have systemic diseases such as thyroid disease, high blood pressure, bleeding disorders, or diabetes.

For more information read my next blog post entilted: Eyelid Surgery: Procedure and Patient Responsibility.

Visit www.gerbermd.com and book your appointment for Eyelid Lift (Blepharoplasties) today.